Missed Gonorrhea Infections by Anatomic Site among Asymptomatic Men who have Sex with Men (MSM) Attending U.S. STD Clinics, 2002-2006

Tuesday, March 11, 2008: 11:00 AM
Northwest 1
Kristen C. Mahle, MPH , Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Donna J. Helms, MPH , Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Matthew R. Golden, MD , Infectious Diseases, Public Health - Seattle & King County, University of Washington, Seattle, WA
Lenore E. Asbel, MD , Division of Disease Control, Philadelphia Department of Public Health and Drexel University, Philadelphia, PA
Thomas Cherneskie, MD, MPH , NYC Department of Health & Mental Hygiene, New York, NY
Beau Gratzer, MPP , Howard Brown Health Center, Chicago, IL
Charlotte K. Kent, PhD , Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Jeffrey D. Klausner, MD, MPH , STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA
Cornelis Rietmeijer, MD, PhD , Denver Public Health Department, Denver, CO
Akbar M. Shahkolahi, PhD , Whitman Wailker Clinic, Washington, DC
Ed Weckerly , Bureau of HIV/STD Prevention, Texas Department of State Health Services, Austin, TX
Hillard S. Weinstock, MD, MPH , The Division of Sexually Transmitted Disease Prevention/Epidemiology and Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA

Asymptomatic infections account for a large proportion of rectal and pharyngeal gonorrhea in MSM. CDC recommends at least annual gonorrhea testing for sexually active MSM at all potentially exposed anatomic sites.

To evaluate the proportion of asymptomatic MSM tested at all exposed anatomic sites and estimate the proportion of infections missed as a result of incomplete testing in STD clinics from 2002-2006.

As part of CDC's MSM Prevalence Monitoring Project, STD clinics in eight cities (Chicago, Denver, District of Columbia, Houston, New York City, Philadelphia, San Francisco, and Seattle) submitted data collected during routine care. City-specific medians and ranges were calculated for gonorrhea positivity and the estimated proportion of infections missed.

Among asymptomatic MSM (n = 36,926), gonorrhea testing occurred in a median of 91.3% (50.8-96.3%) of patient-visits reporting urethral exposure, 64.1% (3.5-91.1%) reporting rectal exposure, and 74.3% (4.5-92.1%) reporting pharyngeal exposure. Asymptomatic men were tested at all exposed anatomic sites during 52.1% (5.2-87.9%) of visits, and at least one test was positive during 5.9% (1.5-10.1%) of these visits. In this group, infections were identified in a median of 1.1% (0.4-2.1%) of urethral specimens, 5.2% (3.4-16.7%) of rectal specimens, and 3.5% (1.0-8.1%) of pharyngeal specimens. To calculate the percent of infections missed in asymptomatic men who were not tested at all reported sites of exposure, we assumed that infections were equally common in both groups. An estimated 8.6% (3.7-49.1%) of urethral infections, 35.3% (8.8-96.4%) of rectal infections, and 25.4% (7.8-95.4%) of pharyngeal infections remained undiagnosed.

A substantial proportion of asymptomatic gonoccocal infections are missed because MSM are not consistently tested at rectal and pharyngeal sites as recommended by CDC.

In asymptomatic MSM visiting STD clinics, routine testing should be conducted at all anatomic sites of exposure.